The role of distal arterial reconstruction in patients with diabetic foot ischemia.

The diabetic foot, a common complication that affects patients with diabetes mellitus, is a therapeutic challenge. It places an increasing burden on society; the patient and caregivers as well as health care systems and clinicians are touched by this problem. The management of the diabetic foot with ischemia consequent to peripheral arterial disease is vexing, often leading to successive amputations. Surgical reconstruction of the peripheral arteries has always been a consideration, although the concept of coexistent small vessel disease has prejudiced the notion of offering reconstructive surgery to these patients. This article examines some of the literature relating to bypass surgery with a view to addressing the aforementioned notion. An appraisal of the literature suggests that vascular reconstructive surgery offers benefits to the diabetic patient, albeit these papers have weaknesses related to study design and methodology. Improved studies are indicated to address the role of bypass surgery to help the diabetic patient with foot complications; it is reasonable to hope that our understanding of the fundamental concepts of the pathogenesis of diabetic foot disease will also improve.